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Individuals who engage in non-suicidal self-injury (NSSI) are heterogeneous across several key features, including functions served by NSSI, frequency of NSSI behaviors, medical severity of injuries, pain experienced during self-injury, and the type and number of methods employed to self-injure. The present study utilized latent class analysis (LCA) to identify distinct subgroups of self-injurers based on a wide array of NSSI features. Participants were 359 undergraduate students with a history of NSSI. Indicator variables of the LCA were the lifetime presence of NSSI methods, number of methods used over one’s lifetime, lifetime and last year frequency rates, presence of NSSI scarring, rating of pain experienced when self-injuring, and functions of NSSI. The analysis yielded four subgroups of self-injurers: a “mild/experimental NSSI” group who endorsed low frequency rates of self-injury and low presence of NSSI functions, a “moderate NSSI” group that endorsed moderate frequency rates of self-injury and moderate presence of NSSI functions, a “moderate multiple functions NSSI” group that endorsed moderate frequency rates of self-injury and high presence of NSSI functions, and a “severe NSSI” group that endorsed high frequency rates of self-injury and high presence of NSSI functions. Following class assignment, groups were found to significantly differ on measures of self-esteem, social support and belongingness, internalizing symptoms, suicidal ideation and behaviors, and other related NSSI constructs. These subtype analyses provide direction for interventions that emphasize matching phenotypes of NSSI to specific interventions based on dimensions of clinical functioning.

The current study investigated whether impaired emotional response inhibition to self-harm stimuli is a risk factor for real-time nonsuicidal self-injury (NSSI) urges. Participants were 60 university students with a history of repetitive NSSI. At baseline, participants completed an emotional stop-signal task assessing response inhibition to self-harm stimuli. Participants subsequently completed an ecological momentary assessment protocol in which they reported negative affect, urgency, and NSSI urge intensity three times daily over a ten-day period. Impaired emotional response inhibition to self-harm stimuli did not evidence a main effect on the strength of momentary NSSI urges. However, emotional response inhibition to self-harm images interacted with momentary negative affect to predict the strength of real-time NSSI urges, after adjusting for emotional response inhibition to neutral images. Our findings suggest that emotional response inhibition deficits specifically to self-harm stimuli may pose vulnerability for increased NSSI urge intensity during real-time, state-level negative affect.

Objective Findings from prior research on reward sensitivity in nonsuicidal self-injury (NSSI) have been mixed. Childhood maltreatment is an independent risk factor for NSSI and for hyposensitivity to rewards. This study aimed to disentangle the role of reward sensitivity as a predictor of NSSI for those with an elevated severity of childhood maltreatment. Method In a diverse undergraduate sample (N = 586), trait reward sensitivity (i.e., behavioral approach system subscales) and the severity of maltreatment were assessed as predictors of a lifetime history of NSSI. In a subset of this sample (n = 51), predictors of NSSI urge intensity were measured using ecological momentary assessment. Results Individuals with elevated maltreatment who reported less positive responsiveness to rewards were more likely to have a lifetime history of NSSI. Those with elevated maltreatment who reported a lower likelihood to approach rewards experienced more intense NSSI urges across the ten-day observation period. However, those with elevated maltreatment who reported a greater likelihood to approach rewards experienced less intense NSSI urges. Conclusions The role of reward sensitivity as a cognitive risk factor for NSSI varies depending on childhood maltreatment history. Findings indicate that, for those with elevated maltreatment, hypersensitivity to approaching rewards may decrease risk for NSSI urges.

BACKGROUND AND OBJECTIVES: Existing models of social anxiety scarcely account for interpersonal stress generation. These models also seldom include interpersonal factors that compound the effects of social anxiety. Given recent findings that two forms of interpersonal distress, perceived burdensomeness and thwarted belongingness, intensify social anxiety and cause interpersonal stress generation, these two constructs may be especially relevant to examining social anxiety and interpersonal stress generation together. DESIGN: The current study extended prior research by examining the role of social anxiety in the occurrence of negative and positive interpersonal events and evaluated whether interpersonal distress moderated these associations. METHODS: Undergraduate students (N = 243; M = 20.46 years; 83% female) completed self-report measures of social anxiety, perceived burdensomeness, and thwarted belongingness, as well as a self-report measure and clinician-rated interview assessing negative and positive interpersonal events that occurred over the past six weeks. RESULTS: Higher levels of social anxiety were associated only with a higher occurrence of negative interpersonal dependent events, after controlling for depressive symptoms. This relationship was stronger among individuals who also reported higher levels of perceived burdensomeness, but not thwarted belongingness. CONCLUSIONS: It may be important to more strongly consider interpersonal stress generation in models of social anxiety.

Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines. During 1998–2008, 48 pediatric residents and 8 psychology fellows trained in this integrated clinical environment. The program’s accomplishments include longevity, faculty and fiscal stability, sustained support from pediatric leadership and community payers, the development in residents and faculty of greater comfort in addressing BH problems and collaborating with BH specialists, and replication of the model in two other primary care settings. In addition to quantitative program outcomes data, the authors present a case example that illustrates how the integrated program works and achieves its goals. They propose that educating residents and psychology trainees side by side in collaborative BH care is clinically and educationally valuable and potentially applicable to other settings. A companion report published in this issue provides results from a study comparing the perceptions of pediatric residents whose primary care continuity clinic took place in this integrated setting with those of residents from the same pediatric residency who had their continuity clinic training in a nonintegrated setting.

Recent criticism of American legal education has focused on its being theory-driven rather than practice driven, which either produces or reinforces a divide or gap between theory and practice. Yet two of its prominent features expressly draw upon experiential learning, one directly by sending students into experiential learning situations (legal clinics) and the other indirectly by bringing instructors who are engaged full-time in active practice into the classroom (adjunct faculty). This article briefly reviews the ambivalent position of clinics and adjunct faculty in American legal education, to explore the degree to which these approaches to skills development can, or should, be transplanted to other systems of legal education. Drawing on accounts of efforts to develop clinical methods in countries with less adversarial systems, it concludes that legal culture is a critical element in the success, or lack thereof, in transplantation of these approaches.

Psychiatric, psychological, and legal observers have noted persistent shortcomings in the quality of evaluations for competence to stand trial since at least 1965 (Vann, 1965). Recent reviews by Nicholson and Norwood (2000) and Wettstein (2005) of multiple studies (10 and 19, respectively) that assessed the quality of criminal forensic evaluations found "the practice of forensic psychological assessment falls far short of its promise" (Nicholson & Norwood, 2000, p. 40) and that "much work remains to be accomplished in improving the quality of forensic evaluations of evaluators with or without specific forensic training and experience" (Wettstein, 2005, p. 172). Remedies proposed include increased training, specialization, certification, and credentialing of forensic evaluators, although a recent study by Frost, Camara, and Earl (2006) found that as of 2005 only 16 states required or encouraged additional training before evaluators could testify, and only 10 had a forensic certification program. Enlarging the pool of potential forensic evaluators would expand those eligible for specialized training, could reduce shortages of evaluators, and would address conflicts of interest for evaluators employed in the public sector and between evaluators and treaters in the same facility--both noted as ongoing problems (Frost et al., 2006). Social workers, the nation's largest category of licensed clinical mental health professionals, are natural candidates for inclusion in an expanded pool of forensic evaluators--especially to evaluate competence to stand trial. Although forensic evaluation statutes in all but six states now allow psychologists and psychiatrists to be forensic evaluators, only seven states explicitly allow other mental health professionals to conduct forensic evaluations--and then often only of certain evaluations or in certain types of cases (Frost et al., 2006). Despite this moderate statutory and regulatory expansion of professionals eligible to conduct forensic evaluations (Frost et al., 2006), trial courts---even without explicit statutory or regulatory authority--are expanding the pool of those who can give expert testimony on competence issues to include clinical social workers based on judges' inherent power to qualify persons as expert witnesses (State v. Reese, 1989; State v. Gans, 1983; State v. Scala, 1985; People v. R. R., 2005; People v. Villanueva, 1988; State v. Torres, 2001; State v. Mackey, 1982; United States v. McCarthy, 1995). Competence questions, the most frequently arising forensic mental health issue in criminal cases, produce an estimated 50,000 to 60,000 evaluations annually (Bonnie & Grisso, 2000; Rogers, Grandjean, Tillbrook, Vitacco, & Sewell, 2001). Social workers in mental health organizations and general hospital psychiatric services have outnumbered combined psychiatrists and psychologists in these facilities since 1990 (National Mental Health Statistics, 1998). Despite the clinical burden competence evaluations impose, the statutes and administrative regulations of only eight states--Connecticut [Conn. Gen. Star. Ann. [section] 54-56d(d) (2006) (as a clinical team member)]; Louisiana [La. Stat. Ann., Code Crim. Pro. Art. 644; Art. 646 (2006) (as a clinical team member)]; Nevada [Nev. Rev. Stat. [section] 178.415 (2006) (for misdemeanors only)]; North Carolina [N.C. Gen. Stat. Ann. [section] 15A-1002; N.C. Admin. Code tit. 10A, r. 27G.0104 (2006)]; South Carolina [S.C. Code 1976 [section][section] 44-23-410; 44-23-10 (2005); S.C. Admin. Code Sec. 87-1 (2005)];Tennessee [Tenn. Code Ann. [section] 33-7-301;Tenn. Comp. R. & Reg. Ch. 0940-3-3.07 (2005)]; Utah [Utah Code Ann. 1953 [section][section] 77-15-5; 62A-15-602(3), 62A15-606 (2005)]; and Washington [West's Rev. Code Wash. 10.77.060.; 10.77.010 (2005)])--explicitly permit appointment of clinical social workers to conduct competence-to-stand-trial evaluations, whereas all 46 states that specify who can perform evaluations allow appointment of any licensed psychiatrist or (in all but one) any licensed psychologist. …

To characterize the differences and similarities among college freshmen, sophomores, juniors, and seniors regarding their sexual behavior including contraception choices and human immunodeficiency virus (HIV) risk.A 41-item sexual behavior questionnaire designed for this study was administered to a convenience sample (N = 797) of a college population.Levels of sexual activity were found to be comparable to other college-based surveys. Notable trends included an increased level of oral contraceptive use among partners reported by seniors, as compared to freshmen, without a corresponding increase in condom use; an increased reliance among seniors, as compared to freshmen, on women to provide contraception; and a low level of self or partner HIV testing either before or after initiating sexual intercourse. Gender differences also revealed greater partner relationship duration, intensity, and communication prior to initiating sexual intercourse among women versus men (por = .001).Sexual behavior among college students differs across the 4 years with regard to rates of intercourse, contraception choice, and responsibility, as well as HIV testing and partner trust. University- and college-based health care programs should address sexual behavior with an awareness of the differences that exist in the four cohorts of students.This study aimed to describe the differences and similarities among college freshmen, sophomores, juniors, and seniors concerning their sexual behavior, including contraception choices and HIV risk. The sample (N = 797; mean age = 19 years) were taken from a private 4-year undergraduate college and represented 17% of the college population. It consisted of 474 (60%) females and 318 (40%) males. They were interviewed through the use of a 41-item questionnaire administered in a cross-sectional survey design. In the results, levels of sexual activity were similar to other college-based surveys with 72% reporting ever having had sexual intercourse. The average age of first sexual intercourse was 16.8 years for females and 16.7 for males; 358 (45%) were currently sexually active. Condoms were the most common contraception used, followed by oral contraceptives. The primary purpose in choosing a contraceptive was prevention of both pregnancy and disease. Seniors had increased level of oral contraceptive use and increased reliance on women to provide contraception as compared to freshmen. The percentage of students who had undergone HIV testing also increased from freshman (16%) to senior (32%) years. As to gender differences, women reported greater partner relationship duration, intensity, and communication prior to initiating sexual intercourse as compared to men. In conclusion, college-based health care programs should address sexual behavior with an awareness of the differences that exist in the 4 cohorts of students.

Purposes: To determine self-reported honesty in completing a sexual and other risk behavior questionnaire among middle and high school students, and to relate honesty scores to sexual behavior item responses as a method to detect bias in reporting. Methods: A self-administered questionnaire measuring overall honesty (7-point rating scale), sexual honesty (5-category scale), and selected sex behaviors was used. Urban, predominantly minority middle and high schools (Grades 7–12) were examined, and participants were 3144 male and female students in middle (mean age=13.7 ± 2.0) and high (17.3 ± 1.6) school health classes. Results: The majority of students stated that they had been very or completely honest in responding to items on the questionnaire. Seventy-eight percent of middle school males (lowest rate), and 94% of high school females (highest rate) reported honesty. Middle school males were most likely to declare dishonesty regarding sexual behavior items, overstating their actual behavior (14%), while middle school girls were most likely to understate (8%) their behavior. Self-reported sexual honesty and reports of behavior were most consistent for understaters. That is, those subjects who answered that their questionnaire responses underreported their true sexual behavior did, in fact, report lower sexual activity on selected survey items. Conclusion:> Middle and late adolescents reported high levels of honesty in responding to a sexuality-related questionnaire. When interpreting such questionnaire data, correction for the tendency to overstate among middle school males and understate among middle school females should be considered; conclusions about self-reports of sexual behavior among young adolescents need to take into account degree of honesty. However, the presence of some overreported and some underreported behavior does not invalidate interpretation of the overall survey findings.

One hundred seventy-eight graduates from four primary care residency training programs with common hospital sites (medicine/pediatrics, 72; family medicine, 29; pediatrics, 35; and internal medicine, 42) responded to a mailed survey questionnaire regarding distribution of professional time and self-perceived clinical competencies. Most of the internists, family physicians, and internist/pediatricians (MED/PED) were in primary care, and 57% of the pediatricians were subspecialists. Respondents rated each of 24 clinical vignettes as to their level of comfort in managing the patient problems presented. MED/PED and pediatricians responded similarly to all the infant, child, and adolescent cases. Family physicians were less comfortable in managing the complicated neonatal situations but more comfortable with adolescent health care than the MED/PED or pediatricians. MED/ PED reported greater comfort than family physicians in complex internal medicine issues, but less than internists in intensive care and geriatric consultation. Significant differences in reported competency existed among these primary care practitioners despite substantially overlapping training backgrounds.

Purpose To determine whether former pediatric residents trained using a model of integrated behavioral health (BH) care in their primary care continuity clinics felt more comfortable managing BH care and better prepared to collaborate with BH professionals than did peers from the same residency who trained in clinics with a conventional model of BH care. Method University of Rochester School of Medicine and Dentistry pediatric residents were assigned to one of two continuity clinic sites. At one site, psychology fellows and faculty were integrated into the clinic teams in the mid-1990s. At the other, conventional patterns of consultation and referral continued. In 2004, the authors surveyed 245 alumni (graduated 1989-2003) about their experiences and their comfort with providing BH care and collaborating with BH providers in their current practice. Results A total of 174 alumni (71%) responded. There were significant differences between graduates who trained in the two models. Those who trained in the integrated model were significantly more likely than others to report that they had consulted or planned treatment with a BH provider during residency and to report that their continuity clinic helped prepare them to collaborate with BH providers. They were somewhat more likely to believe that their overall residency training prepared them to manage BH issues in their current practice. Conclusions These findings suggest that an integrated training environment, described in detail in the companion article in this issue, can enhance pediatric resident education in the management of BH problems and collaboration with BH specialists.

Munchausen Syndrome by Proxy (MSP) is a disturbing diagnosis that should be considered when persistent signs and symptoms defy adequate explanation despite extensive testing. Insistence by a parent (often mother) that more, and particularly invasive investigations be pursued, should serve as a warning sign that MSP might be present. The primary care provider who has an existing, over-time, relationship with the child and family is in an important position to raise the question of MSP because this professional may be able to recognize larger dynamics at play between child and family that are less apparent to subspecialists who are focused on a narrow aspect of the evaluation. A confounding element to identifying MSP can also be at play when parent(s) have become proficient in the jargon and technical communication with which professionals on the healthcare team are most comfortable. This easily occurs in cases of MSP both because frequent hospitalizations offer ample opportunity for the articulate and inquisitive parent to pick up the ways of "medical-speak," and because the World Wide Web provides countless and effortlessly accessible sources of disease related information (albeit not always accurate or relevant to the diagnostic dilemma in question). An additional complicating factor in posing a risk for MSP is the child with a chronic illness, or one whose neonatal course has served to label the child as vulnerable.

Objective Macrophage activation syndrome is characterized by an overwhelming inflammatory reaction driven by excessive expansion of T cells and hemophagocytic macrophages. Levels of soluble interleukin-2 receptor alpha (sIL-2Ralpha) and soluble CD163 (sCD163) may reflect the degree of activation and expansion of T cells and macrophages, respectively. This study was undertaken to assess the value of serum sIL-2Ralpha and sCD163 in diagnosing acute macrophage activation syndrome complicating systemic juvenile idiopathic arthritis (JIA). Methods Enzyme-linked immunosorbent assay was used to assess sIL-2Ralpha and sCD163 levels in sera from 7 patients with acute macrophage activation syndrome complicating systemic JIA and 16 patients with untreated new-onset systemic JIA. The results were correlated with clinical features of established macrophage activation syndrome, including ferritin levels. Results The median level of sIL-2Ralpha in the patients with macrophage activation syndrome was 19,646 pg/ml (interquartile range [IQR] 18,128), compared with 3,787 pg/ml (IQR 3,762) in patients with systemic JIA (P = 0.003). Similarly, the median level of sCD163 in patients with macrophage activation syndrome was 23,000 ng/ml (IQR 14,191), compared with 5,480 ng/ml (IQR 2,635) in patients with systemic JIA (P = 0.017). In 5 of 16 patients with systemic JIA, serum levels of sIL-2Ralpha or sCD163 were comparable with those in patients with acute macrophage activation syndrome. These patients had high inflammatory activity associated with a trend toward lower hemoglobin levels (P = 0.11), lower platelet counts, and significantly higher ferritin levels (P = 0.02). Two of these 5 patients developed overt macrophage activation syndrome several months later. Conclusion Levels of sIL-2Ralpha and sCD163 are promising diagnostic markers for macrophage activation syndrome. They may also help identify patients with subclinical macrophage activation syndrome.

The design, construction, and performance of a tactile sensor and a thermal sensor that can be combine into one compact device with both modalities is discussed. The tactile sensing portion is composed of an 8×8 array of force sensing cells with 1.8 mm center to center spacing. Heat transduction is measured by a 4×4 array of temperature sensors. A number of these devices will be mounted on the Utah-MIT four-fingered dextrous hand, providing a unique research environment for pursuing sensor driven control strategies.

Background/Purpose: Amplified musculoskeletal pain (AMP) syndrome is a debilitating clinical entity primarily affecting adolescent girls in which severe pain and tactile sensitivity (allodynia) are present in a particular body region sometimes with associated signs of pallor, cutaneous hypothermia and atrophy, or pain is in a generalized distribution (fibromyalgia syndrome). Treatment focusing on desensitization, physical reconditioning, and psychological intervention has been suggested as effective therapy. We present our early experience in a protocolized, outpatient AMP program. Methods: Patients seen at the Pediatric Rheumatology group and diagnosed with AMP were referred to the Golisano Children's Hospital Amplified Musculoskeletal Pain Program (GCHAMPP) for evaluation and enrollment in the 8 week outpatient program. There was no restriction on co-morbidities, except conditions preventing ability to participate in intensive physical therapy (PT) and occupational desensitization therapy (OT). Evaluation included assessing muscle strength, endurance, and coordination, as well as psychological screening. The number of PT/OT sessions were individualized (mean = 16, range = 6–28). Results: Of 30 patients enrolled in the program, 93% were female, 90% were Caucasian, and mean age was 14.8 years (range 10–19). 57% successfully completed the full program. All had a return to normal function and 41% had resolution of pain. 35% had initiated psychotherapy/counseling along with PT/OT. Reasons for not completing the program included needing to address other medical conditions (23%) or unknown (46%). Notably, the majority of those who withdrew had not initiated psychotherapy along with PT/OT (69%). More than a quarter of patients could not complete therapy due to insurance non-payment (31%). Conclusion: Our initial experience with a cohort of pediatric patients with AMP validates prior studies showing intensive physical therapy with desensitization is a successful treatment. More than half of our patients completed the program, with all having return to normal function and almost half having resolution of pain. Furthermore, we noted that more than two-thirds of patients who chose to withdraw had not initiated psychotherapy along with PT/OT, suggesting that psychotherapy may allow patients to complete the physical demands of treatment. The other contribution of psychotherapy, and perhaps the more potent influence, is that while the PT/OT is proceeding, psychotherapy is uncovering and addressing the individual and family psychodynamics that are part of the process underlying the onset and perpetuation of symptoms. Notably, one quarter of patients did not complete the program due to failure of insurance carriers to recognize intensive PT/OT as a known treatment for AMP and distinct from the standard PT/OT sessions for other rheumatic or orthopedic conditions. Our findings support the use of intensive therapy and desensitization along with family oriented psychological intervention to treat AMP in a select population of children with pain. Further clinical trials with larger cohorts are necessary to validate these findings.

Background/Purpose: Children with juvenile idiopathic arthritis (JIA) may develop limb asymmetry, thought to be mediated by growth plate hyperemia adjacent to areas of synovial inflammation. Synovial hyperemia signifies active inflammatory arthritis in adults and vessels visible within in the joint capsule are considered abnormal. In growing children, however, blood vessels supplying the growth plate and surrounding areas are frequently visible sonographically even in unaffected joints, but have not been described systematically. We used power Doppler (PD) to compare epiphyseal and growth plate vascularity in affected and contralateral unaffected joints in children with clinically asymmetric inflammatory arthritis. Methods: Children between 2 and 16 years of age who had clinical joint swelling in one ankle or knee but not the contralateral joint were examined with gray scale (GS) and PD ultrasound using a Philips CX50 machine (5–12 mHz linear transducer). Images (GS) and video clips (PD) were taken at the knees (medial, lateral, posteromedial and posterolateral femoral condyles, medial and lateral proximal tibia, and lateral proximal fibula), or ankles (anterior and medial distal tibia and lateral distal fibula), in addition to standard images to document disease activity. Vessels were noted as present or absent in each view, and localized as epiphyseal cartilage, growth plate, or periosteal. Results: Knees of 8 subjects and ankles of 3 subjects were imaged. The most common vessels seen were extraarticular, parallel to the periosteum but not visibly entering cartilage or joint spaces. Vessels were visible in the epiphyseal cartilage in the majority of the lateral femur, medial femur, and anterior distal tibial views, and less frequently in the posterolateral femoral condyle, posteromedial femoral condyle, proximal lateral tibia, proximal medial tibia, and proximal fibula. Four subjects had vessels seen within the growth plate; 3 of these were in the lateral aspect of the knee, and one in the anterior ankle.1 Table 1. Visible vessels by location* total ≥ of paired views Knee distal lateral femur distal medial femur posterolateral femur posteromedial femur proximal medial tibia proximal lateral tibia proximal fibula Ankle distal anteriortibia distal medialtibia distal fibula n = 8 n = 6 n = 7 n = 7 n = 6 n = 8 n = 7 n = 3 n = 3 n = 3 a u a u a u a u a u a u a u a u a u a u a=affected, u=unaffected. a number(percentage) epiphyseal 5 (63)a 6 (75) 4 (67) 4 (67) 1 (14) 0 (0) 2 (29) 0 (0) 2 (33) 2 (33) 3 (38) 3 (38) 1 (14) 2 (29) 1 (33) 2 (67) 0 (0) 0 (0) 0 (0) 0 (0) growth plate 2 (25) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (13) 2 (25) 0 (0) 0 (0) 1 (33) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) periosteal 5 (63) 7 (88) 6 (100) 5 (83) 4 (57) 3 (43) 2 (29) 0 (0) 4 (67) 4 (67) 7 (88) 7 (88) 2 (29) 2 (29) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Conclusion: This is the first study to our knowledge that specifically addresses the sonographic appearance of vessels within the growth plate and epiphyseal cartilage in JIA. These vessels were readily seen, especially within the epiphyseal cartilage, suggesting that this methodology is appropriate for further study. There was no clear difference between vascularity of clinically swollen and unaffected joints. Though this was a small population, this finding raises questions about hyperemia as the mechanism leading to the growth asymmetry seen in children with JIA. Future work should include a larger population, greater age representation to explore differing vascularity related to age and pubertal status, and healthy controls.

To determine the longer-term effect (mean +/- SD, 41.2 +/- 15.3 weeks; range, 14.1-80.5 weeks) of a middle school (MS)- and high school (HS)-based human immunodeficiency virus and sexuality intervention (Rochester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-efficacy, behavior intention, and behaviors.Quasi-experimental design with 3 intervention groups and 1 control group.Urban, predominantly ethnic, minority MS and HS health classes.Middle school and HS students (N = 4001) enrolled in health classes in 10 schools. Fifty percent were African American; 16%, Hispanic; 20%, white; and 14%, other. Less than 10% of the students refused participation.There were 4 study conditions: (1) control, usual health education curriculum taught by a classroom teacher; (2) RAPP adult health educator, intervention curriculum implemented by highly trained health educators; (3) RAPP peer educator, intervention implemented by extensively trained HS students; and (4) a comparison of the RAPP intervention curriculum taught by regular health teachers, implemented with MS students only.A confidential questionnaire was administered to all study subjects before and at long-term follow-up after the intervention, containing scales to measure knowledge, self-efficacy, behavior intention, and behaviors, including onset of sexual intercourse experience and engagement in risky sexual behaviors.Rates of baseline sexual activity in the sample were comparable to those found in other urban school-based surveys. Long-term knowledge (MS females, P.001; and MS males, P.01) and sexual self-efficacy (MS females, P.05; and HS females, P.01) scores were higher among the intervention groups (male and female are used in this study to describe those aged 9(1/2)-23 years). Intention to remain safe regarding sexual behavior was also greater among intervention groups in MS but not HS. However, subjects who were already sexually active at pretest were less likely to show a positive intervention effect. An intervention effect for the onset of intercourse and risky sexual behavior was found most significantly among MS females.A positive long-term effect from the RAPP intervention was observed, particularly for youth who were involved in less risk (eg, not yet sexually active) at study enrollment. Thus, we propose that the most appropriate time for intervention implementation is earlier in adolescence, before the onset of risky behaviors.

Mondor disease is a variant of thrombophlebitis involving the thoracoepigastric lateral thoracic and/or superior epigastric veins. This entity was first described more than 100 years ago by Fagge but gained its eponym in 1939 when four cases of "subcutaneous angiitis" of the chest wall were described by the French surgeon Henry Mondor. All previous reports in the literature describe populations of adult women ranging in age from 21 to 66 years [with a mean of 43 years in one study and 33 years in another]. These reports generally suggest that Mondor disease is a self-limited condition with no increased risk of malignancy or other breast abnormality. However an association between Mondor disease and breast carcinoma has been suggested in a small number of older women. Mondor disease has not previously been described in the adolescent literature; however it is an important consideration in the evaluation of an adolescent with a breast mass or tenderness. (excerpt)

The purpose of this study was: (a) to describe reported access to health care among urban youth, and (b) to compare intention to seek care and risk behaviors for youth who did and did not seek care.A cross-sectional survey measuring knowledge, attitudes, self-efficacy, and behavioral intentions related to sexuality and use of and access to health care was administered to 3,677 urban middle and high school students in health education classes.A total of 13% of students reported no established health care, whereas 25% reported no care within the past 6 months. A physical examination was the most common reason for seeking care. Younger teenagers, males, and those not under care were less aware of teen clinics, thought it more difficult to access care, and had less intention to seek care within the next year (P.001). Older students had greater knowledge and self-efficacy concerning sexual matters, were less positive about abstinence, and higher life and sex risk scores (P.001). Females reported greater self-efficacy regarding sexual matters, were more positive about abstinence, and had lower life risk scores (P.001). Adolescents receiving care had higher knowledge and self-efficacy scores, were more positive about condoms, had greater intention to seek care, but had higher life and sex risk scores.Awareness and use of health care remain low for a sizable number of at risk urban youth, especially younger and male teenagers. The school is a setting in which adolescents not under care can be reached for provision of information about health care.

School-Based Professional vs Peer Education; A Successful Intervention to Reduce High Risk Adolescent Sexual Behavior

Aims: To determine the prevalence of HS in a population of children with CP, and to compare demographic and other features of children with both HS and CP, to those with only HS.

Study of Fatigued Adolescents: the Presentation, Natural History, and Response to Treatment 3

Self-Reported Questionnaire Response Honesty Among Middle and High School Adolescents. † 34

Aims: To: (1) describe the characteristic features of fibromyalgia syndrome (FS) in a pediatric population, (2) note similarities and differences with FS in adults, and (3) ascertain outcome following treatment.

The authors describe a fully implemented computational architecture (CONDOR) that controls the Utah-MIT dexterous hand and other complex robots. The architecture derives its power from the highly efficient real-time environment provided for its control processors, coupled with a development host that allows flexible program development. By mapping the memory of a dedicated group of processors into the address space of a host computer, efficient sharing of system resources between them is possible. The software is characterized by a few simple design concepts but provides the facilities out of which more powerful utilities such as a multiprocessor pseudo-terminal emulator, a transparent and fast file server, and a flexible symbolic debugger could be constructed. >

This article presents a review of the development of coronary care units (CCUs) as a paradigm for the uncritical acceptance of technology in medical services. Studies comparing CCU with other settings for treatment of acute myocardial infarction are described in which intensive care is not shown to offer a consistent benefit over more conservative treatment. The proliferation of CCUs as it relates to corporate involvement in medical research (as argued by Waitzkin) is presented. Finally, methodologies now being applied to improve patient selection for CCU services are summarized.